Round 2 - MRF FMSCI Indian National Rally Championship 2018

COMPETITON NO.

(For official use)

Closing date for Standard Entries : Wednesday, 27th July 2018 @ 2000 hrs

Closing date for Late Entries : Friday, 29th July 2018 @ 1700 hrs

ENTRY FORM Entrant / Competitor First Driver Co-Driver

Team Name      Surname                  First (given)Name                  Place                  GenderBlood Group Date of Birth            

Communication Address      

Telephone (business)                  Telephone (private)                  Mobile                  Fax No.                  Email Address                  FMSCI Comp. Lic. No.                  PAN                  FMSCI IRC Reg. No.                  Driving License No.            

PA Policy Details Policy No. Amount Issued by Valid

FromValidTill

DriverCo- Driver

Details of the CarMake       Registration No.      Model       Capacity – cc      Year of Manufacture       Chassis No.      Group / Class       Engine No.      Homologation No.       Predominant Colour      

Special Rally Cover Insurance Number Company Valid From Valid Till

                       

Name of Tuner      

MRF Rally of Coimbatore 2017Round 1 of 2017 MRF FMSCI INRC

Round 2 - MRF FMSCI Indian National Rally Championship 2018

COMPETITON NO.

(For official use)

Sl. Championship Entry Fees (with Optional Advertising)

Entry Fees(without Optional

Advertising)1 INRC 1 Rs. 37,500/- + 18% GST ( Total Rs.44,250/-)

Double the Entry Fees2 INRC 2 Rs. 32,500/- + 18% GST ( Total Rs.38,350/-) 3 INRC 3 Rs. 27,500/- + 18% GST ( Total Rs.32,450/-) 4 FMSCI 4WD CUP Rs. 20,000/- + 18% GST ( Total Rs.23,600/-) 5 FMSCI 2WD CUP Rs. 10,000/- + 18% GST ( Total Rs.11,800/-)

Team Entrant Manufacturer Entry : Rs. 1,00,000/- + 18% GST = Rs.1,18,000/- ( Additional - Per Car) Team Entrant Others : Rs. 10,000/- + 18% GST = Rs. 11,800/- ( Additional - Per Team) Team should consist of maximum of 3 cars per championship.For this entry form to be valid, it must be accompanied by the appropriate entry fees The entry fees can be paid either by Demand Draft in favour of “COIMBATORE AUTO SPORTS CLUB” payable at COIMBATORE or by Cash or by wire transfer. Bank Central Bank of India IFSC Code of Bank CBIN0280908Branch Coimbatore (908) SB A/c No. 1407019402

Seeding Information

FIA Priority A Year :       FIA Priority B Year :       FMSCI Seed A FMSCI Seed B

Declaration & IndemnityI/We hereby make an application to participate in the above mentioned rally and certify that the particulars of my vehicle as given overleaf are correct, that I/We have read the Supplementary Regulations issued by Organisers for the said rally and agree to be bound by any of the International Sporting Code of the FIA, the General Prescriptions for 4W, Sporting Regulations and Championship Regulations of FMSCI; as well as the undertaking on this entry form.

I have read the Regulations issued for this event and agree to be bound by them. In consideration of the acceptance of this entry, I agree to save harmless and keep indemnified the Government, the FMSCI, the Organisers, the FIA and their officials, the Sponsors, agents, representatives, employees and all persons assisting them in this event and all owners and tenants of private property traversed by this event, from and against all actions, claims, cost, expenses and demands in respect of death or injury to myself or any other person or persons or loss or damage to any property including the car concerned in this event and test, if any or otherwise howsoever and not withstanding that the same may have been contributed or occasioned by the negligence of the Organiser and their official, agents, representatives, employees and all persons assisting them in this event. The indemnity shall be binding on my heirs, executors and legal representatives. I/we declare that I/we shall not post any wrong and or provoking information/comment on social media of any kind neither to any media personnel. All grievances / problems will be addressed through correct procedures as laid down in the sporting code, general prescriptions applicable to the respective event and supplementary regulations of the event.I/We also undertake to compensate and or settle all third party damages of any kind, caused by me/us, my representative/s or who so ever connected with me/us during the event.I declare that the drivers posses the standard competence necessary for an event of this type to which this entry relates, also that the vehicle entered is suitable and rally-worthy for the event. I agree and undertake to abide by the rules and regulations framed for this event including the conditions precedent set out herein and all other rules and regulations, which may hereinafter be framed.

Finally I/We hereby acknowledge that I / We am / are fully conversant with the risk and dangers of Motor Sports in general and this rally in particular which I/WE assume hereby.

Place :       Date :      

                 

Signature of the Entrant Signature of the Driver Signature of the Co-Driver

Name , address & Signature of the witness:

1)       2)      

MRF Rally of Coimbatore 2017Round 1 of 2017 MRF FMSCI INRC

Round 2 - MRF FMSCI Indian National Rally Championship 2018

COMPETITON NO.

(For official use)

Media Information Driver Co-Driver

Name            Place            Date of Birth            Team            Championship Titles            INRC Debut            INRC Wins            Website            

Career Highlights2017            2016            2015            Favourite Motorsports Icon            Hobby            Any other            

           

Signature of the Driver Signature of the Co-Driver

Please send duly completed form to

Coimbatore Auto Sports Club Shop No. 29, Nehru Stadium,COIMBATORE – 641 018.Telephone: +91 422 2380065 E-Mail: casc.cbe@gmail.com Web site: www.casc.org.in

MRF Rally of Coimbatore 2017Round 1 of 2017 MRF FMSCI INRC